1472f•
of ,
NOTE-, ,
With•proper validation / Q
thin±forrri constitutes an CITY OF LA QUINTAo
y encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: june 22. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Rduinment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623 Scrager
14' High. 10' wide. 110.000 lbs
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVA•TION,'IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Haul Date: 6/23/92
Haul Route: Adams to Fred Waring to
Washington
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
`(Including'removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the City, its -authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
o' happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
F Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
}� Signature of Applicant or Agent
Name of•Applicant (plea''"se print) Business Address Telephone No.
Nuevo Engineering 79-811 Country Club Dr., Bermuda Dunes, CA 345-1778
Name of Contractor and Job Foreman Business Address Telephone No.
On Pile On' File r:
i• Contractors License No. City Business License No.
On'File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III 2
p 2 io Q i p `2- 10`
p iHS18CA$Fi ibT�TA 9� 7.0.00
Public improvements: 3%, of estimated construction costs
Private improvements: 3of estimated construction costs'+}
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by
'Recorded by
Date
PERMIT VALIDATION
PERMIT NO. 1472
DATE APPROVED 6/22/92•
EXPIRATION DATE 6/23/92
DATE ISSUED 6/22/92
By
Administrative Authority
TELEPHONE: (619) 564-2246 r
e
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NOT&
With proper validation
11tform constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
.PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers,
and other like public works imprwater inaiiis
ovements in connection with MINOR IMPROVEMENTS and APPROVED SUNDIVISIONS
DATE: 6-22-92
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street eddrett n,
PURPOSE OF CONSTRUCTION 'Move Equipment
DESCRIPTION OF CONSTRUCT (?N 623 Scraper
14' High, 10 W-17, 110;000 1Ts
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and deb:•is, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if appropriate)
Haul Route: Adams to Fred
Waring to Washington.
Haul Date: 6/23/92
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, lost or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the
ted
t to
-four 1241 hours in advance of�the ltime nwhen unip
li
work will bestarted
Notify the Administrative Authority at least twenty ca
tion.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the city of
La Quints and to pay for' any additional replacement necessary as the result of this work.
i Signature of Applicant or Agent
Name of Applicant (please printl a.u: is r i
Business Address Telephone No. h
rinrr Irl -
Name of Contractor and Job Foreman (' ��y r1 uh I)r I�Prmuda f)IrnP_ h U — -I
Business Address
I On Pi I. Telephone No.
Contractor's License No.
Applicant's Insurance Company
r-4: subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
111spection Fee
Permit Fee
enalty
ash Deposit -Surety Bond
required
TOTAL:
pecelpt No.
eceived by
Date
ecorded by
On File
City Guiness License No.
Policy Number
N�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By •A r
Administrative Authority
TELEPHONE: (619) 564.2246